What had happened.

Warning: Random ramble ahead. Proceed at your own risk.

There was this meme that I saw on social media about Secretary Hillary Clinton. It was shortly after she'd clenched the democratic nod and gave her acceptance speech at the DNC. This person had changed her profile picture to the infamous "H" with the arrow and underneath it said these words:

"Girl, I guess I'm with Her."

I have to be honest and say it made me laugh out loud. And while I can't say that meme spoke to exactly how I felt personally, I'd be dishonest if I didn't say that some piece of that statement didn't resonate with me just a tiny bit.

Yeah.

And let me be clear: I was never really not on board. Like, I had been following Hillary Clinton for some time and was fully aware of her tremendous track record. Her commitment to the "least of these" didn't just pop up out of the blue. This woman has been a champion for others her entire adult life. All it takes is just a few moments of looking over her history and you have to admit it to yourself right away that, when it comes to her resume, Hillary Clinton is one dope lady.

Yup.

Dope, in the urban vernacular, is one of the highest compliments one can give. It suggests more than just "cool" or "really good." It suggests that someone is. . .well. . .the ideal. Yeah. That.

So yeah. As far as doing stuff and showing up is concerned, Secretary Clinton is pretty dope. But still. Regardless of that fact, there was something that held some people back from seeing her as universally dope.

Does this even make sense? Let me try to unpack it.

Okay, so check it. When Barack Obama stepped up on the DNC as a senator in 2004, I felt my heart racing. His voice, his swagger, his intelligence, his essence grabbed me by the chest and pulled me in close. And maybe I was late to it all, but honestly, this was the first time I'd really heard of him.

Yep. I admit it.

But after that, I started following him. I read about him, learned about him and joined the legions of folks who hoped this man would run for President. Yup. And damn, was I among the over-the-moon elated who jumped for joy when he said that indeed he would.

Yep.

Being with him was a no brainer. Not only did I like his policies and plans for our future (and I respect that some reading this did not) the thing I recall the most was liking him. He was cool. His infectious smile made me do the same. He was this biracial man who identified with black culture and navigated it so smoothly that it welcomed others in instead of making them feel like outsiders. And all of it was amazing.

Universally dope, even.

I had an Obama sign on my lawn. I canvassed parts of Atlanta and made some phone calls. I genuinely cried big, fat crocodile tears when I couldn't go with my friends to Washington D.C. for the first Inauguration and cried through the entire swearing in. That was a magical time. We didn't need a sign to tell us that this symbolized hope. We felt it.

And listen--this is not a post designed to polarize. Like, I am aware that some of my friends who read this blog felt true sorrow during this time that stands out as a special piece of my life history. I respect that, too. I do. But really, I'm just trying to understand my emotions about the recent election process and the outcome. Reflecting on the last candidate I supported is a part of that.

I hope that makes sense.

Anyways. So even though I knew for sure that Secretary Clinton was highly qualified, every time she stood up to speak, I felt nondescript. And no. It wasn't like this overwhelming sense of distrust, which does happen sometimes with people I see or encounter. But more just this mourning I felt and longing for the connectivity my heart immediately felt for Barack Obama.

The first time I cast a vote in a presidential election, I was 18 years old. It was an absentee vote for Bill Clinton and I sent that form in with glee. He, too, left me giddy. And at 18, seeing a presidential candidate playing a saxophone on a late night talk show?

Chile please.

I was older when I voted for John Kerry. I honestly liked him, too. It felt good to get behind him. It did. And no. It wasn't Barack Obama good. But good. Big and pregnant, I pushed the button with his name on it. Sure did.

Bernie made me smile a lot. His curmudgeonly passion ignited a lot in me and especially in my husband. And, okay, pound for pound I'd say that as far as the "like" button goes, I found him more likable. Yeah, yeah, I'll admit it. I "felt the Bern." But not in this overwhelming way like I'd felt in 2004 and 2008. So I was sort of left with this in between feeling. Like, "I sure appreciate y'all putting your hat in the circle and riding hard for folks like me and my patients." But that was about it.

Yeah.

So as things reached a fever pitch and Secretary Clinton's campaign rolled forward, I did my duty as a card carrying democrat. I gave money and spoke positively. And though I did feel annoyed by the whole email scandal thing and how distracting it became, I got on board with the pantsuit nation. But as I look back, I think I did it in that way you do something you're supposed to do, you know? Like a middle school kid who washes dishes without being asked.

Awful analogy, I know.

But the thing is, that's why that meme is in my head right now. The "I guess I'm with her" sentiment oozed out of the world of Instagram and Facebook and made its way into hearts and minds. This seething indifference brewed in the very people who metaphorically marched on Washington to get Barack Obama elected not once, but twice. And it was unfortunate.

I was with her. But I realize now that it wasn't in the way that I was with him. Even though I wanted to be.

Does this even remotely make sense?  Sigh. I don't know.

So I guess beyond the stunned feeling, I'm conflicted. I'm not so sure I or even we left it all on the field this time. The lukewarm emotion that some of us felt was probably telling. And the fact that a meme that said "I guess I'm with her" going viral might have been a sign.

Maybe. Maybe not.

Here's what I know for sure. It's not enough to galvanize people to vote against someone. The masses need to feel driven to vote for the party's endorsed candidate. And though qualifications matter, it seems like liking the person matters, too. Not just from the popular vote standpoint but obviously all the way up to the level of the electoral college. I don't know the answer to making all of that happen. I don't.

To those who were truly, deeply with Hillary Clinton from the very start and to the very end, I apologize for letting you down. I eventually got on board but today wish I'd gotten on with all of my heart like I did in 2004. And while I did vote and give to the campaign, I guess I'm just realizing that this isn't enough. It just isn't.

So what happened has happened. It did and it has.

And I get it that someone will find this offensive. Like it's indicative of some self hate I have for myself as a woman or the idea of a woman as Commander in Chief. But I think a lot and in my heart of hearts,  I don't think it was the woman thing. I don't. I guess I'm just thinking that it was this absence of universal dopeness thing that created a gigantic "meh" for the people who needed to be more plugged in.

Yeah. That.

See, when folks like us elect the people we want? It takes moving a few people out of the woodworks. And some part of that is strictly by qualifications. But another part is overcoming the "meh" with a feeling of deep connection.

There was a video I saw the day before the election. It was the first time I saw Hillary Clinton as universally dope. I wish I'd seen it before and felt what I felt when watching that video before Election Day eve. I really, really do. Because today I'm feeling a new kind of burn.

And something tells me I'm not alone.

Yeah.

***
Happy Thursday.

Couldn't figure out how to embed this really dope video. But here's the link.

https://www.facebook.com/hillaryclinton/videos/1318546694868523/

High Achiever Inertia.

(Rambling, idea sorting and unpacking ahead. Consider yourselves warned. )

"Keep on movin'. Don't stop like the hands of time."

~ Soul II Soul

____________________________________________________


I remember logging into the protected residency website that houses all of the call schedules a few years back. Waiting for the page to open has always felt like spinning a wheel on Wheel of Fortune--nearly every possible wedge upon which the wheel can land is mostly good with only the very rare BANKRUPT tab. That said, even rarer is the $5000 mark that happens about as frequently as a lunar eclipse. The resident and intern assignment odds are fortunately better than game show ones. The chances of hitting it big are much greater and, even better, the BANKRUPT tab is nearly nonexistent.

(reference photo for folks to young to get the reference.)

Yup.

So this particular month, Vanna White was on my side. I scanned the list and did the slow Tiger Woods fist pump.

No, seriously. Almost exactly like this:

Yes. I'd hit it BIG on the scheduling game show this time. Matter of fact, this was right up there with somebody yelling out, "A NEW CAR!"

Oh yeah, baby.

Interns: solid. Medical students: Not familiar with them but likely solid, too. But the Tiger Woods celebratory gesture? Oh that was for the person designated to lighten my load--the resident assigned as my right hand woman. The scheduling gods blessed me with a RISING CHIEF RESIDENT. Did you get that? Let me explain. See, this senior resident assigned to me had already been asked to be a chief resident--which in a land of smart people is a big deal. So suffice it to say, she was as smart as five whips cracking all at the same time on the same behind. Now that? That's smart, baby.

Mmm hmmm.

So yeah. I did the happy dance and bragged to a few of my colleagues when queried about my resident for the coming month. It was the summer time and let me tell you--the living was about to be easy. For me, at least.

Now. Sure, I went through those fleeting thoughts of terror with regard to working with someone so smart and highly competent. And yeah, I shuddered a few times imagining some clinical curve ball being hit directly to me and, instead of knocking it out of the park, completely striking out. . . only to have the uber-genius future chief resident come right behind me and smash a grand slam into the rafters. Off of the same pitch.

Yeah. I thought those things but honestly, this resident was not only smart and a future chief resident--she was someone that I knew fairly well already. We'd had a good working relationship from the clinic so I knew that this would be a piece of cake.

Oh yeah, baby.

Now. Let me just discuss for a bit on just WHY I was so happy about this assignment. The truth is that it wasn't just about the fact that she was bright and pleasant and considered one of our best. If I am honest--and I try hard to be on this blog--it was more an opportunity to put my brain on ice for a little while. No--not from the patient care standpoint so much. More from the stressors of looking over my shoulder and under every little nook and cranny for something wrong.

And.

No sort of remediation would be needed. What. So. Ever. Hallelujah, man.

And so. I was going to show up with a plan to simply let this superstar resident do her thing. Because the word was not only out on her level of competence--I'd seen it first hand. Moreover, she was in her final year of residency so what was the point of me coming up with some sort of hair brained scheme to transform her in any kind of way?

And this? This is what I am reflecting on today. This thing that I have discovered that happens with a lot of high performing individuals after a while. This point where, instead of us pushing hard and finding ways to help them excel in new ways, we simply shut off all of our faculties and put it all into cruise control. And you know what? Even though it doesn't feel that way, it's like giving up.

Yeah. I said it. Giving up.

It's so pervasive, too. Even though it doesn't create a mutiny and even though for the most part the learners themselves don't even know it's happening--it is. A lot. Even with the really, really great educators it is.

It is.

Sure, at the beginning we push them and applaud their every milestone but there is this threshold that gets crossed where, as I mentioned before, the word is out. He or she is uber-exceptional and has already been given some sort of metaphorical gold star to prove it. So what do we do? We throw our hands behind our heads, lean back in our chairs, and snooze for a little while.

And okay, okay. If you don't like me saying "we" I will just go ahead and raise my own hand and say "me." Because not only have I been guilty of it, now that I am thinking about it and dissecting this idea, I recognize it as something that happened to me at several different points in my training and beyond.

Let me explain.

Usually it starts with some person planting a seed about just WHO this person you're working with is and just how awesome-great-amazing-the best-superstarish-thebombdotcom that they are. And sometimes you've seen it for yourself but a lot of times, you haven't. You just roll with it. Then the person shows up and what you see is through that lens. Which is mostly fine. And often accurate.

But.

What happens next is the thing that since that month with Tiffany (the rising chief resident assigned to me that year) that I've been trying to fight. It's a sort of inertia. I like to call it "high achiever inertia." This point where everyone sort of gives up on trying to do anything special to bring out an even better version of the person who everyone is telling you is already the best.

Did that even make sense? Stay with me. I'm going somewhere,

So check it. Usually there are heaps and heaps of flattery involved. From the start whether warranted or not, the person is lauded as fantastic and a star before they've even done one thing. As time marches on, the sweet words prove to be as empty as sweet foods--delicious to hear but of no real nutritional value. Feedback sessions morph into these nondescript proclamations of excellence without examples. And the person on the receiving in--who is human--eats it all up without even realizing that it was not a balanced meal at all. Or worse--that for the last several months, they've been fed the same, exact plate of food.

Yup.

I know how this feels. I lived through the "hey, you're going to be chief resident!" announcement and experienced the stealthy downshift in meaningful nudging toward new potentials that came from those who worked with me. And I didn't even know it was happening for the most part. I didn't.

Then, during my chief year, my Internal Medicine chairman, Dr. Blinkhorn, started having these weekly meetings with me. He'd give me specific feedback on my teaching and would ask me provocative questions about how I was running my ward teams. He wanted to know about the feedback I gave to learners, what I did at the bedside, and more. The points I made on the chalkboard--though often salient--he challenged. Questions like, "Who are your learners?" and "Do you think that was as effective as it could have been?" were common. He'd even say to me, "You look exhilarated. I can tell that session felt good and like you were in the zone up there today. Let's talk about why."

And that? That was awesome. Just freaking awesome.

Two or three days into working with Tiffany, things were going fine. It was as I had anticipated: She was exceptional in a myriad of ways and I was enjoying the welcomed diastole that came with along with it. But then something happened with a patient. Nothing wrong at all. Just a situation where I watched this excellent resident physician navigate one aspect of patient care into which my personal experience afforded me insight. And so. I took a moment to chat with her about it.

Yep.

Something about that conversation triggered an onslaught of memories. Specifically, I was transported back to those Tuesdays with Blinkhorn and just how pivotal they'd been for me. I put that on a post-it note in my head and vowed to come back to it later that day.

And I did.

That lead to a gigantic ah hah moment. Dr. Blinkhorn did something that very few people had done for me. He fought against the downhill momentum of "high achiever inertia." This was more than someone choosing to push a learner from good to great. This was something that was, in my opinion, even more profound. He approached his chief residents--the ones he'd personally selected--as if he could move them from what many perceived as great to even greater. And instilled in me this idea that we are never ever there. The destination is always moving higher and higher, forcing us all into a zone of development that we deserve.

Yes. That. This zone of development--not some high achiever comfort zone where everything morphs into the predictable and straightforward and hence the default of flattery takes the place of real, true strategy.  That.

So that got my wheels turning. And so. I asked myself:

What if. . . like. . . what if I actually set out to do something transformative with this learner? This one. This known-to-be-already-excellent learner? What if, in spite of everyone saying "oh me, oh my, your resident is awesome". . . what if I actually had the audacity to think that I could still do something to push her deeper into the zone of development? What if? What would that even look like? What would that even feel like? And. . . what would that take? What would that mean to a learner like Tiffany who, by everyone's standards, is at the top of the pack for her current level? Hell, what would it mean to me?

Well. I'll tell you. It would mean planning on my part. It would involve thinking and preparing in ways that I hadn't before. It would call for a boldness and a confidence that I'd not yet fully challenged myself with and a trust in my own ability to actually do something meaningful with someone like her. That was uncharted territory for me. So was I insecure about it? You bet I was.

Let me tell you what happened. It was transformative indeed. But not just for Tiffany. It pushed me into a zone of development and called for something more from me. I tapped into creativity and honesty that had previously lay dormant in such situations and the outcome? Man. It was awesome. 

Yeah.

So I guess that's what I've been thinking about. How to not give up on the high achievers or the proficient performers. And you know? This isn't just in the work place, either. This can be applied in other aspects of life, too. Kind of like the way your child who calls for more academic or personal attention from you somehow seems to get all of it, while (hallelujah) the other one just plugs away independently. In between moments with the needier one, you do what just might be the minimum--checking always finished and correct homework, giving high fives, and feeling grateful as all get out. Which is fine sometimes but when sustained is really no different that that same idea of coasting along in the cruise control of high achiever inertia.

Or in this case, easy kid inertia. 

Whoops. My bad. If your toes hurt from that last part, just know that the person who stepped on them has just had hers crushed as well.

Ummm yeah.


But I digress. So let me get back to a professional context before some toes get amputated.

I guess the thing is. . . . .these guys will usually be fine, you know? These high achievers--they will. And some piece of you knows it which is why we don't fully freak out  about or even think about this--as the giver-upper or the giver-uppee. But imagine--just imagine--what it would be like if they, too, got the level of thought and preparation as everyone? Or better yet, more than just back slaps and applause to fuel their independent development?

I think those greats would be even greater. And, even better, they'd pay it forward first chance they got.  You'd better believe they would. At some point, at least.

When Tiffany finished her chief residency, during her parting words she said one of the kindest, most memorable and most encouraging things I've ever heard any learner or colleague say about me to date. And, at the risk of sounding self important, I will share it--not because I need to puff out my chest--but more because what she said serves as a tangible affirmation of something I was really trying to do. As lofty as it sounds, I was trying to be transformative. I should also note that Tiffany was known for being stoic which made her words just that much more meaningful.

She said:

"No attending had more influence on me during my training than her. Doing a month on wards with Kim Manning as your attending should be a required part of our curriculum for all residents."

Yes. That is what this high achiever who'd already been asked to be chief resident, who'd arrived on my team as "one of those residents that everyone knows is awesome," and who just maybe knew more medical facts than me said in my earshot to a roomful of people.

Uhhh, yeah.

This simple statement will always be high on the list of the proudest moments of my career to date. Because I knew how hard I'd tried. And you know what else? It moved me so greatly that I quickly typed it nearly verbatim into my the my phone for posterity.

Okay maybe posterity is a strong word. But I at least wanted to have those words to revisit and unpack for later.

Sigh.

Here's the thing: No award was given with it. And nope, no plaque, publication, or confetti either. But that? What she said that day? Man. That's what I hear in my head on my shittiest days. It's what pumps me up when I feel myself giving up or falling into a lazy pattern that isn't unique to THAT learner.

Is it exhausting? Hell yes. But the reward is insurmountable. And freaking awesome.

Look. I can't say that every strong learner that I've encountered before Tiffany W. got some watered down, lazy educational experience from me. But I think the difference is that the level of intention I have when working with those performing at that level changed. And thanks to her, I actually believed I could make a difference. Even with the less junior trainees, I started to believe I could.

Yep.

So that's what happened. And that's what I challenge myself to do every single chance I get. For the known superstars, yes. But also for the ones who are superstars in disguise.

Which reminds me: I wish I had time to talk to y'all about how a lot of superstars get mistaken for average.

Mmmm hmmmm.

But that's another subject from another post. Oh. It's in this one, actually.

Ha.

Okay. This has been long enough so let me just wrap it up with this final thought:

If you keep trying at this and being intentional about what you do with every single learner, after a while perhaps a different word will get out. Yeah, man. Not that you're just nice or competent or full of random facts.  Maybe an expectation will get handed around that this person--you--just might be bold enough to try to transform those working with you. Even if they're not a problem child or someone super junior or someone who's been dubbed "just okay." Yes. Even if that person is known to be a star, the rumor might be that you'll still try to make them shine even brighter or in ways they hadn't before. So then no one will show up expecting an experience with you to be super-comfy and vanilla.

Nope.

They'll arrive with a nervous disposition expecting to be a little uncomfortable. Not too uncomfortable. Just kind of. I mean, maybe this could happen, you know? This could be the new word on the street when it comes to you. Even amongst the superstars.

with Tiffany at her Chief Resident farewell program

Then guess what? YOU'LL get forced into a zone of development right along with them. . . . . .the same one that we're all hungry to inhabit but that we don't realize we craved until we're there.

Yeah.

Jen S. and Lucas G. -- two that challenge me constantly. And I love it.

****

Okay. Here's the challenge for everyone reading this who works with someone excellent: Don't give up on them. Don't just float on your back in the pool basking in the sunshine without moving. Because when that happens on your watch, they stagnate. And when they stagnate you do, too. But guess what? When you push them into the zone of development, you go there, too.

Every. Single. Time.

*Based on Vygotsky's Zone of Proximal development--a concept that I like.

***
Happy Sunday.

Whew. That was a lot. I know. And maybe it made zero sense to you. And maybe it set off alarms for you instead. But either way, I appreciate you letting me unpack, okay? I really do. Keep on moving, y'all.

Now playing on my mental iPod. . . . a song that blasted in my dorm room many a day and many a night circa 1990. Soul II Soul singing "Keep on movin'."

The calm before the storm.

I could see it revving up. Her voice was growing louder and there wasn't any eye contact. Arms twitching in a tightly folded position, seated with crossed legs and a foot that kept rhythmically kicking. Whatever it was that was going on wasn't good.

Nope.

I wasn't involved actually. At that moment, I just happened to be down in the Emergency Department looking for a patient who'd already been wheeled upstairs. I'd popped over to one of the computers to check a few labs before hustling upstairs to find my sixty-something year-old man with heart failure.

She was propped on the edge of a gurney just a few feet away from where I was standing. A young doctor was speaking to her and a nurse was nearby doing industrious things that appeared to be in preparation for the patient to be discharged. And me, I could just see it. This patient did not look happy. But it was more than that. Her fuse appeared short.

Very short.

And so. Like someone rubber necking at a car wreck, I stood frozen and watching. Some perverse part of me wanting to be able to say, "See? I told you so" and needing proof of the outcome before I could.

Terrible, I know.

I could overhear bits and pieces of it. Mostly the issue seemed to be that she wanted a "head-to-toe CAT scan" which her doctor didn't seem to think was indicated. Her agenda wasn't being met and she wasn't too thrilled about that.

"What if I got cancer?" she said.

"Ma'am," he responded, "from what I've seen so far, we shouldn't expose you to all the radiation."

"I am fine with the radiation. I want you to check me all the way out for cancer. From head to toes with a CAT scan. It's my body. I know what I need."

And that young resident doctor just sighed and tried once again to take a different angle. None of which was working.

Now. You'd think that this wasn't really a big deal, right? But here is the part I could discern--partly from working at Grady for a long time but also just from something I felt in my gut: Her impulse control was on 'E.' And that meant 'E' as in empty.

"We're going to go ahead and discharge you now. I'm going to schedule you a follow up appointment in the Primary Care Center, okay?" That's what he said to her. Easy enough.

But that twitching foot started going faster. Her chest was heaving in and out and her eyes were flitting all about. She was sitting on the edge of that hallway bed and, from what I could see, was all alone. No loved one appeared to be pacing nearby.  It was just her. A young woman who appeared, really, to have not a single medical problem. But clearly something was wrong.

Very.

And so. It all began to swirl in slow motion. The nurse tried to hand her the after visit summary and her arms stayed tightly pressed to her torso. Her lip curled and her eyes rolled. Her nurse tried a little bit more, hand making karate chops to her flattened palm to reason with her one last time. All of it at a snail's pace. At least, from my perspective. The nurse then walked away, clearly exasperated but fighting to hold on to any threads of empathy. And that young woman swept her hand across the bed, flinging that discharge paper work to the floor. My breath hitched as everything went silent. In the pregnant pause, I watched them float down to the slick linoleum like feathers.

And then, someone hit fast forward.

First came the expletives. Loud, unruly and landing all over the emergency departments in awkward, awful splats. B-words and F-bombs screamed with reckless abandon, not to the individual caregivers per se, but to the system, the moment, the everything. And I just stood there like some terrible voyeur watching it all unfold. Wondering, wondering, wondering what had broken this young woman down so much that she'd unravel like this and lose every shred of impulse control?

What?

Was it a shitty existence at home? Screaming kids and no help or money? A horrible childhood that left her with so much noise between her ears that she couldn't quiet it no matter how hard she tried? Someone not nice awaiting her, with nasty words and swinging fists? Mental illness that was under treated? Or not even diagnosed?

Or.

Just a young woman who had none of those issues at all. Who just happened to be a bit nervous about her health and who was hoping for fool-proof means of making sure it was all clean?

Maybe.

And so. I tried making eye contact with her. Hoping to untrouble her waters from afar which is really a crazy and rather self important thing to believe I could do. But I did anyway. And, of course, it didn't work.

Eventually security came. Bear hugged her and lifted her feet above the ground. One of her shoes flew off and she was reduced to one bare kicking right foot and one sneaker-covered left one. They were nice-ish too her, despite her vitriol, but still they had to do their job. Which was to protect the other patients and the staff in the ER.

Sigh.

Now. I wish I could tell you that his ended with me walking over and hugging her. Me giving her a card to come to the clinic and her promising through tear-streaked cheeks to do just that. But it didn't. It ended ugly. Like, as angry as she was, there wasn't a way to do this in a dignified way. There just wasn't. So this was it. A lumpy ending that left everyone trapped in that awkward moment where you glance all around like you didn't see what just happened.

And that was that.

As I walked out of the ED, I started thinking. Thinking about that aura before the meltdown. Those folded arms, that tapping foot, that complex scowl. I replayed it and wondered what, if anything, could have been done to preemptively strike. To throw baking powder on the grease fire before it blows up the kitchen.

And no. I'm not criticizing my emergency medicine colleagues at all. Quite the contrary, actually. I guess I just wondered if, with that kind of knowledge, that kind of premonition if you will, what I would have done. And would it have even made a difference.

I guess the thing is. .  . . loss of impulse control is never normal if you ask me. Sometimes it's due to some mood altering substance, sure. It wears off and provides a sound explanation. But other times it is just life. Big fists punching or little tiny fists pummeling all at once. . .manifesting as nothing to lose.

Sigh.

I just want to be a better doctor and human being, man. I think we get these little prickles under our skin for a reason. Sometimes it's all because you need to haul ass and get out of the situation. But what if, in this line of work especially, it's a signal to rush in? To try your best to knock the door down before it gets blown off and hits you in the face?

Honestly, I don't know the answer to that. I don't. But that's what I'm thinking about tonight. And what I will likely be thinking about for a long time.

Yeah.

***
Happy Thanksgiving-eve.

Feet of clay.

"I'm just saying, you could do better."

~ Drake

I was a few steps behind her as she climbed up the three or four stairs leading into Grady Hospital. In her hand I saw that she was carrying one of those venti sized coffee milkshake drinks complete with whipped cream and what looked like chocolate syrup on top. She wrapped her lips around the unusually large-diametered straw and slurped hard. My pace was faster than hers. It didn't take very long for me to catch up with her.

"G'morning," I said in what was likely the most mundane way ever. She pulled the straw from her mouth, nodded at me and returned the gesture.

By my estimation, she was definitely younger than me. That said, her face lacked the mischief or innocence of youth so I'd say that she was definitely "grown" and maybe even somebody's mother. Her skin was of a deep pecan color with eyes peeking from above her ample cheeks like two tiny slits. The sides of her face looked to be almost painted with this darker brown hyper pigmentation and, in that moment, the doctor in me sifted through my brain for the mechanism behind when such a thing happens when people carry lots of extra weight.

Hmmm. Acanthosis nigricans, maybe? Or even kind of like melasma or "the mask of pregnancy," I thought to myself. Except this she didn't appear to be pregnant at all. Just obese.

Very, very obese, to be clear.

example of facial acanthosis, from this source (not the person)

Even without trying I could hear her laborious breaths as I walked along side her. She was mouth breathing, yet balancing it with savoring deep swallows of what was surely a beverage well over her daily allowance of calories. Without even stopping myself, I made an unfair inventory of what I imagined to be her morning diet--some unrestricted three thousand calories, most likely. She pulled back on the straw once more, her cheeks hollowing at the sides followed by more panting.

Ugggh.

Confession: I could already feel my insides cringing, my nose metaphorically wrinkling with disdain. With each slurp, I noticed more things about her. The ill-fitting stretch pants that did little to hide the amorphous lumps that made up her buttocks and thighs, the wide feet folding over her distressed flip flops, the rippled upper arms that easily exceeded the size of my thighs--or likely even both of them.

Now she knows that she doesn't need to be drinking that. Words I mostly thought, but that I probably would have uttered to Harry under my breath had he been beside me at the time.

Just then, I caught a glimpse of the crumpled McDonald's bag in her other hand and immediately formed more unsolicited opinions about that choice as well. Judging. Disapproving. And almost--dare I say it? Disgusted to some degree. And you know? I'd be lying if I said that wasn't  true of what went on in my head. I'm also ashamed to say that such thoughts have probably entered my mind countless times before. Even though they were fleeting--seconds at most--they were there. They were.

Yeah.

It was in the morning at Grady Hospital so there were many other passersby with me. They cast their glances in her direction as she shuffled up through the lobby. I could tell that many of them had those same thoughts yet the vast majority did little if anything to mask them. And so I let myself see what was happening--around me, in me--as it related to this innocent woman. The more I watched, the more I could see them; adjectives swirling all around her, pasting themselves to her swarthy cheekbones, her gelatinous arms, her abundant abdominal folds.

Fat. Lazy. Shiftless. Disgusting. Morbid. Invisible.

Her eyes kept shifting downward and away from those she encountered. It was automatic, a part of a shield of armor that immediately formed around her in such situations. The more I watched the more I saw. Person after person grimacing their faces or even shaking their heads--right out in the open where she could see, feel, and be stung by it all.

Yes.

Of course, many of those who tsk-tsked her could stand to shed a few of their own pounds. But now she was in a different realm. She had the kind of body habitus that had crossed over into the kind that drew stares and widened eyes from little children who don't know any better and adults who should. The kind that made single seats on commercial airplanes out of the question and even seatbelt restraints in a car a gamble. So yes, she'd moved into that public spectacle kind of obesity, making her a target for all of the stares, yes. But none of the pity.

Wow.

Just that morning, I'd turned the radio station away from NPR because I was just too tired of hearing about all of these unfortunate examples of discrimination against black people making the headlines. Black boys gunned down in Missouri, the President of the free world who gets openly dissed day after day, and yet another NBA franchise owner spitting out venomous words about the fans who look like me or even having those same ideas discovered via email. Ugggh. Too much. Next my mind wandered to the op-ed pieces I've read on these same subjects, my eyes scrolling down to those nasty, racial slurs in the comment section from those internet trolls, all crouching tigers and hidden dragons in their anonymous virtual worlds.

But this? This, that I was not only seeing but even participating in, was as messed up and discriminatory as anything. And worse--none of it was even hidden from sight. Blatant, open, egregious prejudices not because of race or sexual orientation or identity. . . . but because of something universally affecting someone in every one of every group you can think of: weight.

Yep. And here I was, no less guilty than the rest of making her a pariah. Yes. That. A pariah.

Terrible.

Movies have won awards for complex tales of interracial loves fighting for familial acceptance. And, it seems, that the world has gotten or at least is getting the memo that it isn't cool to just outwardly let the world know that NO your child can't marry some black person or HELL NO you aren't interested in meeting the man your boy has fallen in love with and now calls his "soul mate." I mean, not publicly it isn't. Your job is to bury it under concerns like "cultural difficulties" or "religious beliefs" -- because everybody knows that you can't just come right on out and say, "I just don't approve because I think black people are gross and have tails" or "I'm glad to watch them, the gays, on TV but beyond that I want them no where near me and my family" And sure, okay, people still do it but when they do, the backlash is swift and mighty. Those are the ones that lead to "closed comments" on the NYTimes from all of the folks marching on Washington in those free-text boxes.

Yes.

Yet somehow with obesity it's different. Socially acceptable to shudder where others can see you or text some hurtful observation to a friend. No one is super pissed, or rather, as pissed off as they would be about such open discrimination in any other group. And even worse, with obesity, the good guys are often in cahoots with the bad guys making it all exponentially worse.

So here's what I am trying to work through: I'm trying to rage against my own machine--the imperfect human being with not nice thoughts. I am thinking of the hurt I have felt when watching the news or listening to news radio about my own people being mistreated and how important it is for me to push myself to see my own shortcomings toward others. My hope is that it will give me more empathy toward those who think negatively of me just from looking in my direction.

Whew. I just sort of need to unpack on this today. This idea that Michael Jackson had about starting with the man--or rather woman--in the mirror.

Oh. And let me be clear: I get it. Obese people were not brought here against their will on slave ships, oppressed for hundreds of years and horrifically disadvantaged historically. But I guess my point is that I don't think there needs to be a pissing contest to see who has been treated the worst. Instead, as we all fight for equality for the groups closest to our hearts, families and identities, that can't ever happen if we aren't willing to self reflect on what we are doing, feeling and thinking about the ones that aren't.

Does that even make sense?

Here's the truth:

I didn't even know that woman. I don't know her life story, her trials, her upbringing, her resources, her support, or any such thing about her. I don't. And while I think it is perfectly okay for me to want a healthier life for her (and myself, too) I know it's not okay for me to make up my mind that all of this represents laziness and self-loathing. I know as well as anyone that obesity isn't that simple and can't just be chalked up to being unmotivated. And you know? Even if it were, is it kind of me to focus just on that part without considering all of the things that may have led to that point? Hell no it isn't.

In my opinion, society graduates discrimination, you know? Like . . . for example. . . . .the most obese people have it the worst but even still those who are still heavy but haven't quite reached a pariah-status body mass index still have it tough. Surely the most effeminate gay man or the most masculine lesbian woman or the transgender individual has a harder row to hoe than the queer-ish person with a  phenotypically vanilla identity. And last, I am keenly aware that the darkest of my brothers and sisters with the most afrocentric features, particularly when combined with the most limitations on socioeconomic status, struggle more than perhaps I do with my smattering of freckles and more delicate facial features. It's just the truth. But even still, the discrimination is there and it hurts that it is.

Try compounding a few of these things together--particularly with obesity or even some mental or physical disability. Very, very obese and black. BMI over 40 and transgender. Or all of these things plus a cerebral palsy or a cognitive disability? Better yet, don't. It will only depress you.

I guess a big part of me always embracing members of, for example,  the LGBTQ community has been about this shared understanding of how it feels to be prejudged and mistreated as a group and how vital it is to us all to just be seen, man. But I wonder sometimes if part of it is just because it is socially acceptable for me to do so? I mean, I hope not. Either way, today I am working to expand my views to include more than just what is "sexy."

You know what? I'm a work in progress, man. And I'm going to work as hard as I can to "see" even more people than I ever have before. . . .but to especially keep self reflecting enough to see--and deal with--my own feet of clay in the process.

Yeah.

³¹ “Your Majesty looked, and there before you stood a large statue—an enormous, dazzling statue, awesome in appearance. ³² The head of the statue was made of pure gold, its chest and arms of silver, its belly and thighs of bronze, ³³ its legs of iron, its feet partly of iron and partly of baked clay. ³⁴ While you were watching, a rock was cut out, but not by human hands. It struck the statue on its feet of iron and clay and smashed them."

- Daniel 2:31-34 

***
Happy Wednesday. And I'm just saying, we can do better. Me included.

 Oh, and if you haven't seen this? Watch it and be intrigued. It's complicated, man.

                                                                    

Team S.J.G.R. Thursday Huddle: Do the right thing.

I saw this patient today who was smart. Far too smart for what he was doing and, in addition, asking his doctor to do as well. I was seeing this gentleman with a resident physician and before going into the room his provider reviewed the plan of care with me.

"His hemoglobin A1C is over ten and his blood sugar today is in the 400 range. That said, he's not too keen on insulin so I guess we'll try to up is pills. And then as far as his cholesterol goes, he's said he doesn't want anything and that he'd watch what he eats."

"Wow. What about the blood pressure?" I asked.

"It's almost controlled but not perfect. He would likely benefit from a second agent since he smokes but he's not having it. So I guess I will just work with what I have. Maybe refer him to nutrition to lower his salt and give the quit line number to quit smoking."

"That's it? This plan sounds kind of bootleg, man." (Yes, this is how I speak to my residents sometimes. #dontjudgeme)

"I mean. . . what can you do? He doesn't want what I'm recommending. So I guess I just have to work around that, you know?"

Now. Let me just unpack on this for a second. Would that be okay? Don't mind if I do.


But before I do, let me tell you a little more about what happened when I met this patient. Honestly, I was expecting some overweight dude who would appear older than his age. Thick middle, thinning hair, and a defiant attitude. What I found was nothing like that.

This man wasn't too overweight at all. Sure, he smoked but he didn't look very old. And that's good because he was actually a little younger than me. And really, he wasn't difficult to interact with or any such thing. Matter of fact, he was a pretty cool dude.

I asked him some questions and he gave me answers. I explored his family situation (married with high school and adult kids and five grandkids) and his siblings, parents, and upbringing. Part of a big family. Lots of love and support. Used to be an athlete. Works a good job with benefits. And seemed to have plenty to live for.

But then, upon further questioning, he reveals to me that not only his father but recently his brother passed away from a heart attack. Both of whom were under the age of fifty.

Yes.

Now. Despite all that, he was refusing insulin ("I don't do needles!"), pushing back about blood pressure pills ("Those things is 'dick killers.'"), shutting down cholesterol management ("I'll just skip eggs") and still smoking ("I try to quit but my nerves get too bad.") And this? This right here--when coupled with his family history--wasn't just unfortunate. It was stupid.

Yeah, I said it. Stupid.

We all do stupid things. Like, I remember my first year of medical school when I was madly in love with this guy for like six very intense months almost to the point of messing up in school. Oh, and I also racked up a ridiculously high phone bill despite zero income coming in. And even with my phone about to be disconnected, I kept accruing more charges. Plus I kept catching him in tall tale lies which were red flags, but I ignored all that. And that? That was unfortunate, yes. But mostly, it was stupid. You know what, though? That shit wasn't life or death. And it wasn't threatening to rob a family of their patriarch.

It's the same with people shaking salt and drinking sugar and never exercising and then either avoiding their doctor or blaming them for confronting them about it all. Not just unfortunate--but stupid. Especially when the person KNOWS the right thing to do.

This man knew what he needed to do. But he was resisting. And yes, we talked about his feelings and trepidations and excavated why he felt the way he did. We uncovered some things and got at a few things but he still threw up road blocks to allowing us to offer him the standard of medical care. Instead he wanted us to come up with some cockamamie plan B.

"You know? This is like somebody asking you to paint their house and giving you a tiny paint brush and some first grade tempera paint. It doesn't make sense. At all."

That's what I said. And I said it because it was true. Because this man knew better. He did. So I flat out told him that we will make recommendations that do right by him and that he is grown and can decide how he'd like to proceed. But as far as this play-play regimen he was asking his resident doctor to piece together for him? Like the Grady elders say: "That dog don't hunt."

Now the good news is that the patient came around. We had a good talk and we connected and he agreed to do the right thing. But really that isn't the point. The point is that this--this knowledge of the right thing to do but a refusal to do it-- is so, so common and is probably responsible more than anything else for killing us softly when it doesn't have to. I do give this brother credit for at least coming to the doctor. Turns out that for his job, they check blood pressure so the necessity of being signed off forces him in to see us. So he tries to go for the minimum. A la carte medical management, if you will.

I will jump on my primary care physician soap box and say that it's not fair to your doctor when this happens. Asking us to offer you substandard care because you aren't ready to accept what is tried and true. Or what will work. And I swear that I am also guilty. My doctor tells me to get certain lab tests or exams and I factor whether or not it is worth getting socked in the pocket for. Sometimes I'm a good egg and sometimes not. Now I have a great PCP that holds my feet to the fire. She ignores my BS and nudges me to do the right things.

And so I do. (Mostly.)

We need to cut this shit OUT. This practice of highly, highly intelligent people making stupid choices when they know better. Like knowing that your family history is effed up but eating high fat, salty things every day anyway. Or having high ass blood pressure and other risk factors for heart disease yet operating as if you don't. No, that's not just unfortunate. That's stupid.

And doing all of those things AND not being under a doctor's care? That makes you more than stupid. It makes you an assassin. Yes. THAT. An assassin of yourSELF. Which is a damn shame.

Sigh.

In the movie Forrest Gump (one of my favorites, along with Do the Right Thing) Tom Hanks' character Forrest was a simple guy. There was a lot of stuff he just didn't know or get. So if, say, Forrest Gump decided to drink sweet tea and full sugar sodas and eat french fries and not exercise in the face of crappy genetics, a spare tire, and cardiovascular risk factors at least we could chalk that up to him not knowing better. So here is my question: What is our excuse?

If you are savvy enough to read a blog or be on Facebook or click on Twitter or whatever techie things you do, then surely--SURELY--you are among those who are learned enough to know the right things to do. And see, at some point when we keep ignoring what we know to be right, something unfortunate happens.

With that boy, I failed a biochem midterm and got called into the Dean's office. I also got confronted by the ("Oh, I forgot to tell you that I sort of have a"-)girlfriend. Yes. The one that he'd had the entire time we'd been together (unbeknownst to me) which was as awkwardly bad as it sounds. And yeah, all of that was unfortunate. But it wasn't life threatening. It wasn't.

This? This avoidance, denial stuff when it comes to cardiovascular risk? That's not awkwardly bad. Instead, it's just sad. Or least, it will become that way eventually.

Damn. I'm all up in your faces, aren't I? But I guess I'm just frustrated with this crazy do loop we get into. And this do loop becomes a death spiral if we don't grab the handles by both hands and right the plane back upward.

Yup.

I broke up with the boy, got a tutor and ended up doing just fine in Biochemistry. I became a doctor, I got to marry Harry and, allegedly, that girlfriend became that boy's wife at some point. So hallelujah that all of that worked out. For everybody. And hallelujah that nobody got really, truly, severely, irreversibly hurt in the process.

I wish heart disease was that simple. It isn't though.

Ask yourself: Do you know what "the right thing" is when it comes to your health? Or at least sort of, do you? If not, find out. If so, ask yourself this out loud:

"Am I an assassin?"

If you aren't raging against this machine called heart disease with all of our might? That answer is YES.

Sorry to unpack. And yes, my toes hurt after this one, too.

Shit Just Got Real, y'all. Let's do the right thing, a'ight?

***
Happy Huddle Day.

A reminder from da mayor. . . . 


Love and hate. . . . . often how we feel about the balance between doing right and doing not-right. Right?


Remember Radio Raheem's good word about how love wins: "Left hand hate K.O.'d by love."  Say word! We can DO this.

I just looked around and he's gone.

Martin Luther King, Jr. and James Weldon Johnson.

"How can you know where you're going 
when you don't know where you've been?"

This mama was very proud.

Warning: I'm in the mood to unpack some thoughts here. . . .

Okay. First, this. As promised, I've uploaded the clips of Zachary and Isaiah from their black history month presentations last week. This was a part of the "Living Black History Museum" that the kids participated in as a part of the Atlanta Chapter of Jack and Jill of America. It was seriously one of the coolest things ever, man.

Confession: This might have been one of the proudest days I've had in a very long time.  Therefore I should give the disclaimer that while it may not seem earth-shattering to you, the mama in me was over the moon.

Over. The. Moon.

Let me tell you why:

See. . . . it's really important to me that my children are comfortable in their skin. I want them to be accepting and welcoming to all people regardless of their ethnicity, orientation, or socioeconomic status. But I also want them to be equally as accepting of who THEY are. I think it's possible to create a space for everyone without divorcing yourself from who YOU are. Or at least where your people have been and what it took to get you where you are.

Jackie Robinson and W.E.B. Dubois

You know? Sometimes minority kids fight so hard to assimilate with the mainstream that they look exhausted. Like really, truly exhausted. Then there are some others that don't seem exhausted with assimilation at all. Starting from the earliest age they morph so beautifully into the majority that every trace of their cultural heritage becomes invisible. And then habitually ignoring who they are culturally to fit in becomes the default. 

Yep. 

This is common, too. And while it may not be really egregious and is more pervasive, it happens a lot. So if no one is reminding them about the "where they've beens" then it eventually disappears. Again, in subtle ways. Like drifting so far away that your eyes can't see someone like your mother or your grandmother as the beauty standard. Or reaching a point of feeling paradoxically uncomfortable in situations where you aren't the minority.

It doesn't have to be that way. It doesn't. But stand by idly and it will.
 
I feel so fortunate to have been exposed to things growing up that didn't put me in that camp. I know it makes me a better doctor at Grady and a kick ass liaison for those cultural nuances unique to the patients I care for with our residents and medical students. If I wasn't okay with the similarities I share with my patients, imagine the teachable moments I'd miss! The Grady elders and their Jim Crow struggles are my uncles and aunties. The woman talking on the phone in the hallway was one of the girls I double-dutched with until the street lights came on. And the music rattling the speakers of the hooptie driving by the front of the hospital? That was from the block on which I grew up. So no. None of that is foreign to me at all. And it sure as hell doesn't make me feel uncomfortable. I thank my parents for helping me with that. Helping me to be alright with me and the "where I'm from" as well as the "where we've been."

Look--I'm all ears when you start telling me your story, too. I want to know all about the state your parents came from in India. I am interested in the stories your grandmother told you of her time escaping persecution as a person of Jewish faith in Europe. Tell me all about your celebration that you'll be having at the end of Ramadan and describe what it means to eat halal meat. Oh, and please, my African sister--don't hesitate to explain the differences between what it means to be Igbo or Yoruba. Break it down for me how even though you are Nigerian, that those distinctions still matter to you because that better describes who you and your family are. And you know? Even if you think your background is more American vanilla than ethnic sprinkles and you can't think of any unique features culturally--know that I still want to hear about it. Talk all about the pies your mama made on the weekends or better yet, the TV dinners you had instead. Whatever it is, I want to know. Because all of us have culture and things that make us who we are. And all of us should be able to hold on to a piece of that without hiding it behind the shadows of what seems standard.

So share it and I will listen. I will.

Frederick Douglass

But please. Sit at the same rapt attention as I speak of my people in months beyond February. Welcome my children to embrace you and yours but offer them plenty of room to stand tall in their heritage, too. Their rich heritage. I never want them to shrink. Or know more about Miley Cyrus than they do about the Middle Passage. Or even worse, just become completely indifferent altogether to all things that aren't culturally nondescript.

Yeah.

Dominique Dawes, gymnast

I don't want that. I really, really don't. And no, this doesn't mean that I take issue with families filled with mixed heritages or that I'll shun a future girlfriend who doesn't look like me. Actually, quite the contrary. But that said. . . .I just don't want my boys to grow up counting their own people out. Looking through certain girls because that's not a part of their "beautiful" definition. And that happens--it does--so, so much with some of our beautiful brown boys. It's like. . .I don't know. . .they don't even see the girls that look like their sister as viable options. And I'm not making a sweeping statement about ALL brown boys in primarily majority settings, but I am saying that it's not too unusual for that to happen. I guess I just want my kids to grow up seeing everyone--and counting themselves in that number of who they see. I mean, why shouldn't someone like your own mother have a fighting chance at being seen as your ideal?

Sigh.

Anyways. I guess I just think the world is so much more interesting when people celebrate their differences instead of hiding them. Or worse--just ignoring them to the point that they have no idea how to even begin to celebrate them.

See? This is some complicated shit. And since we are all thinkers here, I think it's a good dialogue. It kind of brings me back to "The Nod." I guess I'm just hoping my boys grow up instinctively giving it.

Wow I'm rambling. And majorly unpacking.

Man. Sorry about that. But what better time than February, right?

Okay. Let me get off of that soapbox and onto my proud mama soapbox instead. I was so, so proud. My Isaiah can get nervous speaking in front of crowds. So for him to choose Martin Luther King, Jr. and then knowingly put himself in a position to have to talk to person after person like that was a huge deal.

And as for Zachary? He wanted to learn "Lift Every Voice and Sing" so that he could sing it to his class and during this presentation. That was his idea. And you know? It's one thing to sing it once for your first grade class--which still took a hell of a lot of courage--but it's an entirely different thing to stand next to a presentation board and sing it over and over again to all who came to visit your station. Not just adults either. Kids, too. And we all know how kids can be. He must have sung that song fifteen to twenty times. And each time, he sang it like he meant it, just like his Grandpa told him he should.

He messes up a few prepositions. But otherwise? It was perfect. A perfect way to honor the "where we've been." Isaiah stood right by encouraging him each time he had to sing. Giving him thumbs up and smiling. You can even catch it in the video if you pay attention. And Isaiah did that each time.  (Unless, of course, somebody was looking for their old friend Martin.)

Heh.

So here are the clips which I assure you are short. I'm glad I uploaded them because they will remind me of a promise I made to myself today. It's my goal to try to keep my sons so aware of the "where they've beens" that it never even occurs to them to ignore or forget it.

Or allow anyone else to make that part of them so invisible that they start believing that they should too.

Yeah.

***
Happy Monday-almost-Tuesday.

Zachary's Lift Every Voice and Sing from Kimberly Manning on Vimeo.

Isaiah as MLK Jr from Kimberly Manning on Vimeo.

And this, for those who are so young that they don't get the references to "my old friend Martin." Or to the reference in the title. This is my favorite version.



This version is for Sister Moon. It's my second favorite. 


BOB DYLAN - Abraham, Martin And  John (1980) by giemmevu

A different world.

 

I know my parents love me,
Stand behind me come what may.
I know now that I'm ready,
Because I finally heard them say
It's a different world from where you come from.

Here's a chance to make it,
If we focus on our goals.
If you dish it we can take it,
Just remember you've been told
It's a different world from where you come from.
It's a different world from where you come from.

~ from "A Different World" (as sung by Ms. Aretha Franklin)

_____________________________

He couldn't have been any more than four years old. Yet somehow, someway someone had found a pair of designer "skinny fit" jeans that fit him exactly like the ones that the big boys wore. Tight on the calf and the ankle. Loose enough through the waist to fall just under the lower curvature of his gluteus maximus. More of his underwear was showing than not.

And, I am not kidding you, he could not have been any older than four.

Next to him, there was a very young woman. Her belly was taut with a late term pregnancy and it seemed that considerably less thought had gone into her look. Thread bare stretch pants slung up on her hips, a very tight t-shirt that likely fit much better before she was with child. Despite her pendulous appendages up front, she seemed to have little concern with restraining them by a bra. Or concern for much of anything beyond the conversation she was having on the cell phone in her hand.

"Ha ha ha. . . f--k that!" she said with a loud laugh to whomever was on the line. "Girl, I bet his dumb ass was lyin'!"  She paused for a moment and then erupted into more laughter, this time in likely response to what she heard on the other end.

Meanwhile, the little boy was standing directly beside her. Right there in the Grady lobby. I couldn't help but study his young face. There was this weird mixture of complete innocence yet comfort with everything happening around him. Unfazed by the bustling crowd of people pushing through those revolving doors. Not even the least bit conflicted by the profane words and mature conversation falling straight into his young ears. He yawned; then he plunged two of his fingers into his mouth and began sucking them mindlessly. At that point, his eyes seemed to retreat into some distant, soothing place.

"Why the f--k he think somebody gon' believe that sh-t? N--ga! That's some bullsh-t! F--k that! Sh----t, girl I woulda told that n--ga , 'Oh you got me f--ked up!'" She snapped her fingers at the little boy to get his attention. By now, he was twirling one of the short loc twists in his hair and zoning out with those two fingers. He didn't notice. She snapped two more times, this time louder, followed by her reaching over to pull his hand from his mouth at the elbow.

"Girl, uggh. Sticking his nasty ass fingers in his mouth like it ain't no germs up in here!" She kept talking into the phone and never even addressed the child. "Yeah, girl. We at Grady and this n--ga got his hands in his mouth like it ain't all kind of sh-t up in this b--ch." He glanced up into her eyes and then looked off again. And again, nothing about any of it seemed to alarm him in any way.

Which reminds me.

There was once this time when I was around Isaiah's age that my parents agreed to let me sleep over the at the home of these kids who lived on my street. These kids played double dutch with me under street lights and made up dance routines on roller skates to songs by the group Chic. So, yes, we were all compadres and mostly the same as far as I was concerned.

I remember asking several times if I could "spen-na-night" at their home back then and how we'd plot and plan all day for it after a long day of playing outdoors. Almost always, mom said no. But one day, I guess she was in a good mood and agreed.

Now. It wasn't like this house was a few blocks away. It was, like, only a few houses down so that yes became a party within just ten minutes. I stuffed a few Barbies and a toothbrush into a bag along with a nightgown and went sprinting out of the door.

Simple enough, right?

But you know? Here is what I remember from that night. While I was there, some adults got into an argument. A knock down, drag-out, hollering-and-screaming altercation. The profanity was amplified and uncensored. F-bombs were being slung all around and someone threw something like a cup or a plastic bowl at the other person. And all of it just kept escalating right there in front of us kids who happened to be sitting on the floor playing "Hungry Hungry Hippos."

I was terrified. That I absolutely recall. Yet the other thing that struck me that day was that my neighbors weren't afraid. They weren't. It was like those kids had been there and done that. And no, I don't think they particularly enjoyed any of it but they definitely weren't shaking with fear like me.

"I'm gonna go home," I said. I know I was crying when I did, too, because none of this was in my comfort zone. The response to that told it all.

"Why? Noooo!" My friends pleaded with me. They wanted me to overlook the flying Tupperware and expletives long enough to play another Hasbro game.

"I gotta go home. I . . gotta . . .go home." And with that, I grabbed my bag and scooted out into the night air toward my house. And you know? It wasn't until then that they started crying, too.

Yeah.

I knew then that my world was different. My innocence had been fiercely protected by my parents and those around me. And no, I didn't fully know how fortunate I was but I do know that I felt very relieved once I got back into my home. Mom and Dad didn't make a huge deal out of it, I don't think. We still played outside together and organized our neighborhood pop locking groups.

But I never spent the night again. Nor did I even ask.

Yeah.

That little boy in the lobby at Grady made me return to that memory. His ease with all of that took me back to the way my friend continued slamming her hand down on her Hungry, Hungry Hippo button despite all that chaos. It also let me know that my children are also in a different world.

All of this often makes me feel so . . .  so. . . . I don't know. While I look back on how committed our parents were to preserving our home environment, I'm so grateful that they didn't prohibit us from interacting with those whose lives were different than our own. And especially that their careful reactions to things didn't teach me to look down upon them.

A friend of mine recently lamented to me about a recent influx of "less-than-desirable" families at her child's school. And before anyone puffs out their chest, pounds their fist down on a table and says, "Define 'less-than-desirable' families!"-- just go ahead and admit that, though not a politically correct thing to say, you probably have some idea of what she meant. The people she described sounded a lot like that young, pregnant mother in her skin tight t-shirt dropping off her pre-schooler in his sagging True Religion jeans.  Ones that may or may not have some questionable parenting styles.

May or may not.

"Oh hell no," she said with a shake of her head. "No way." And I just listened and tried my best to sift it all through my brain. Like, what it means to intermingle your children with those kids who've already had their innocence robbed and what that means to your children and theirs. Whether it's okay to run hard and fast away from those folks willing to drop unabridged curse-word laden soliloquies under impressionable young ears. But also whether it's equally detrimental to quarantine our kids from all of that, too.

Kind of like the black male medical student I once advised who admitted to me that he was "sometimes uncomfortable" around large numbers of African-Americans. And that he felt most "at home" when surrounded by those who actually weren't culturally like him. Then again, maybe they were more like him culturally than his afrocentric peers. Now that? That I don't know how to feel about. I think I mostly didn't like hearing that and remember thinking to myself that I needed to do any and everything to make certain that my children didn't feel like that.

Yeah.

I don't know the answers. To any of it, to be honest. Like, I don't know where protection ends and bourgeoisie superiority begins. Where exposure and acceptance end and denial and discrimination begin. I don't.

And before I forget: Let me just also say that the friend with the school concern is a good soul with a heart for all people including her own. She is. And all of this is complicated because when it comes to our children, the ground rules all change sometimes. Wait. Don't they?

Hell if I know.

Man, I'm just looking for some kind of intermediate place. So I constantly reflect on my upbringing and try my best to wrap my brain around all of the awesome and intentional choices my parents made. Because I know for certain that they somehow achieved that happy medium. I know this because I don't flinch at Grady Hospital or when I ride the MARTA. I mostly see some piece of myself in most people and can find their beauty on most days. But admittedly, I'm not as good at this as Harry. And you know? He grew up in a different world than the one I came from.

Which wasn't a bad one. Just. . .less innocent, I'd say. Yeah. That.

And despite all that, the rules get muddy with our children. We want them to stay innocent. We want you to keep your slacked pants and exposed underwear to yourselves. And your big, bold expletives over there. And honestly, I'm sort of conflicted by all of that. Especially when it starts to separate my children from a lot of kids who look like them.

Or who simply don't have what they have. Because while parts of this may sound like a black thing, I know for absolute certain that socioeconomic disparities can affect every shade of the rainbow. And that? That's a whole separate blog post, man.

Sigh.

No. I don't have any of the answers. But these are things I think about. And I want to believe that the first step is just that. Always that.

Yeah.

***
Happy Tuesday. And thanks for letting me unpack.

Now playing on my mental iPod. . . .